20210687 Ver 1_Shoreline Stabilization_20210920

Shoreline Stabilization Application Form
15ANCAC 02H .0500 — Water QualityCertification, Shoreline Stabilization
FORM SSGP 10-2013
DRAFT -NOT FOR USE AT THIS TINE
Submission Form
Pre -Filing Meeting Information
Before submitting this form please ensure you have submitted the Pre -Filing Meeting Request Form as we will not be able
to accept your application without this important first step. The Pre -Filing Meeting Request Form is used in accordance
with 40 C.F.R. Section 121.4(a) "At least 30 days prior to submitting a certification request, the project proponent shall
request a pre -filing meeting with the certifying agency" and in accordance with 40 C.F.R. Section 121.5(b)(7), and (c)(5)
all certification requests shall include documentation that a pre -filing meeting request was submitted to the certifying
authority at least 30 days prior to submitting the certification request. Click here to read more information on when this
form is needed prior to application submission or here to view the form.
Attach documentation of Pre -Filing Meeting Request here:
DWR Pre -Filing Meeting Request Form.pdf 51.97KB
Pre -fling Meeting or Request Date 3/28/2021
ID# 20210687
I. Applicant Information [15A NCAC 02H .0502(a)]
Version 1
Please note: fields marked with a red asterisk * below are required. You will not be able to submit the form until all
mandatory questions are answered.
Primary Contact Email *
[e-mail]
Rease provide an email address for payrrent and requests for pore information here.
Owner Information:
Name:* Terry Dennis
Email: * [e-mail]
Phone Number:* [phone]
(xxx)xxx-xxxx
Mailing Address:* Street Address
1930 River Road
Address Line 2
City
Troy
Rbstal / Zip Code
27371
State / Rovince / Region
North Carolina
Country
USA

Is there an agent working on the
project?*
r Yes
C: No
Project Information [15A NCAC 02H .0502(a) & (b)]
Project Name:*
Dennis Shoreline Holiday Shores
If your project has a formal name please use this. If your project does not have a formal name, please identify your project by
the owner name and proposed activity (Jones Property Access Road, Smith Guest House, etc.) List in parentheses any
other names that have been used to identify the project in the past.
1. Provide a vicinity map (i.e. street map) clearly showing the location of the property with respect
to local landmarks such as towns, rivers, and roads.*
r Upload File
C: Look up address
Property Address Lookup:*
Latitude:*
35.341929
Street Address
305 Lakewood Circle
Address Line 2
City State / Bovine/ Region
Troy NC
Fbstal / Zip Code Country
27371 US
Longitude:* -80.064249
2. Provide a detailed site plan showing property boundaries and proposed locations of vegetation clearing,
structures (buildings, retaining walls, docks, impervious surfaces, etc.), rip rap, excavation or dredging
below Full Pond/ Normal Water Level elevations, and construction access corridors. You may use the
diagram under section 12.normal pool lake level/normal water level*
Shoreline Permit Drawing.pdf 2.08MB
Please use the diagram at the link below:
https://edocs.deq.nc.gov/WaterResources/0/edoc/616616/Shoreline%20Layout.docx
3. Attach a photograph of the shoreline/ buffer proposed to be stabilized. (Include a scale of some sort- a
yard stick, shovel handle, etc.)*
20210617_093837.pdf l .85MB
20210617_093834.pdf 1.95MB
4. Location of the property (where work is to be conducted)
Nearest Town:*
County: *
Lake/ river/ ocean adjacent to
property:
Troy
Montgomery
Lake Tillery
Subdivisions name or site address: * Holiday Shores - 305 Lakewood Circle - Troy NC 27371
Include phase/lot nunber
Directions to site:*
24/27 from Troy Turn RIGHT onto River Road, 2.5 miles LEFT onto
Holiday Drive, slight LEFT onto Lakewood Circle, Aprox .25 miles Lot is
on RIGHT
Rease include road nacres and nurrt ers, landmarks etc.

5. Describe the existing land use or condition of the site at the time of this application:*
Lot has been cleared and basement laid out and dug. Shoreline has not
been cleared.
Residential, undeveloped, etc.
6. Property Size .48
Acres
7. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary):
We are wanting to clear off the 5 foot wide strip of land that is above the
water line but on duke energy land.
8. How will the work be done?*
rJ From Land
r From Water
9. Total amount of disturbance below the normal pool lake level/ normal water level:*
(including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
200
square feet
10. Total amount of disturbance above the normal pool lake level/ normal water level and 50 feet
land -ward:*
(including all clearing, back fill, excavation, rip rap, retaining walls, etc.)
700
square feet
11. Please describe the vegetation above the normal pool lake level/ normal water level and 50 feet
landward to be impacted:*
(nunber of trees, for instance)
Around 5 smaller trees and some small low lying vegetation as in weeds
and shrubs.
Sketch: lake lot map for clearing pdf.pdf 34.79KB
Application Fee:
Once the application has been accepted. You will need to send a corresponding fee in with the appropriate DWR#. The
application fee is as follows (pursuant to G.S. 143-215.3D):
a $240.00 for impacts to lake (below normal water level) of less than 1 acre
a $570.00 for impacts to lake (below normal water level) of greater or equal to 1 acre
By digitally signing below, I certify that:
a I, the project proponent, hereby certifies that all information contained herein is true, accurate, and complete to the
best of my knowledge and belief
a I, the project proponent, hereby requests that the certifying authority review and take action on this CWA 401
certification request within the applicable reasonable period of time.
a I agree that submission of this Shoreline Stabilization online form is a "transaction" subject to Chapter 66, Article 40 of
the NC General Statutes (the "Uniform Electronic Transactions Act");
a I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes
(the "Uniform Electronic Transactions Act");
a I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature; AND
I intend to electronically sign and submit the Shoreline Stabilization online form.
Full Name:* Terry Dennis

Signature:
fey/ PeJJ/vvS
Submittal Date: 9/18/2021

Initial Review
Is this accepted into the review C' Yes 0 No
process?*
Project Number:* 20210687
Select Reviewer:*
Select Reviewing Office:
Has payment been received?*
What amount is owed?*
Version:* 1
Chad Turlington:eads\ccturlington
Fayetteville Regional Office - [phone]
✓ No Payment Needed
✓ Fee Received
C' Need Fee - send electronic notification
C' $240.00
✓ $570.00

Owner/Agent's Signature* L15A NCAC 02H .0502(fl] Date
*Agent's signature is valid only if an
•
_ • o M E
12. Please approximately sketch the following information on this plan and provide dimensions
J
1
vmer
c.
•v•iw6.:; item:
1
AMMIE..-
14.2
•
tr'
re'
,..w lusw
vcgetation clearing
ti
N rmal Water Leve
Shoreline
n Vw
/Rd, fra) 0 1,1
s
�. `�.�.: M!.:ced above the Full Pond/Normal Water Level elevation
or
- 1
u i 9K
Lake
(At FBI! Pared/ Normal Water Level)
510 7,ftyles 6e.riow
rnexciA i\rie 740 4.5/0Pe
Nfo irm2 sec.tt war, %/,
[-)Ct er,
1
3 \ 0rde2 1" 4tJ�..TGr
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I
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Le rat fer
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&lc, w tAiii•cr ; loirt e
7
x 1611
3 0 sgt.f,
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DWR Pre -Filing Meeting Request Form
ID#*
Regional Office *
Reviewer List*
20210687
Version*
1
Fayetteville Regional Office - [phone]
Chad Turlington
Pre -Filing Meeting Request submitted 3/28/2021
Contact Name * Kyle Dennis
Contact Email Address* [e-mail]
Project Name * Dennis Shoreline Holiday Shores
Project Owner* Terry Dennis
Project County* Montgomery
Owner Address: Street Address
293 Lakewood Cr
Address Line 2
Vacant Lot Beside this address
City State / Rovince / Region
Troy NC
Fbstal / Zip Code Country
27371 US
Is this a transportation project?* ( Yes C No
Type(s) of approval sought from the DWR:
I— 401 Water Quality Certification - I— 401 Water Quality Certification -
Reg ula r Express
I— Individual Permit I— Modification
l Shoreline Stabilization
Does this project have an existing project ID#?*
C Yes ( No
Do you know the name of the staff member you would like to request a meeting with?
Please give a brief project description below and include location information.*
We are looking to clear off this lot to build a home and a boat house
on property. Please see map attached for location of property. We
are open to meet and date requested. we also own the property
above the lot highlighted on map and would like to clear it off also.

Please give a couple of dates you are available for a meeting.
Please attach the documentation you would like to have the meeting about.
lake lot for dock.pdf
pdf only
168.85KB
By digitally signing below, I certify that I have read and understood that per the Federal Clean Water Act Section
401 Certification Rule the following statements:
• This form completes the requirement of the Pre -Filing Meeting Request in the Clean Water Act Section 401 Certification
Rule.
• I understand by signing this form that I cannot submit my application until 30 calendar days after this pre -filing
meeting request.
• !also understand that DWR is not required to respond or grant the meeting request.
Your project's thirty -day clock started upon receipt of this application. You will receive notification regarding meeting location
and time if a meeting is necessary. You will receive notification when the thirty -day clock has expired, and you can submit an
application.
Signature
Oewirea
Submittal Date 3/28/2021